Republicans are facing deep political potholes as they move down the road of repealing and replacing Obamacare.
The major obstacles were clearer than ever before as President Trump, House Speaker Paul Ryan and other GOP leaders spent Tuesday touting their newly-released legislation to reshape the Affordable Care Act but leave some of its basic frameworks in place — a strategy that opened them up to sharp criticism from all sides.
Conservative House and Senate members threatened full revolt, calling the plan “Obamacare Lite.” Influential groups including Heritage Action and Americans for Prosperity panned the plan for the same reason, saying it leaves way too much of the law intact.
Democrats, who opposed the repeal effort from the get-go, said they’re ready to pummel their GOP colleagues at committee markups on Wednesday over how the plan would likely leave fewer people insured. Hospital and doctors associations cited similar worries that it would result in loss of coverage.
Aides and analysts privately bemoaned its provisions repealing insurer regulations and adding in abortion restrictions that likely can’t pass muster under special Senate rules.
And while the bill is softer on Medicaid expansion than previous iterations, allowing ongoing enrollment if states choose and reducing the federal contribution only for enrollees after 2020, it’s unclear whether that’s enough to pacify Senate moderates, who have warned they won’t support a replacement that hurts the low-income.
“We’re working through the language of the bill,” is all Colorado Sen. Cory Gardner would say Tuesday afternoon, when asked whether he’ll support the measure.
Gardner and three other Republican senators from states that expanded Medicaid wrote to leadership earlier this week warning they won’t support a replacement plan that undermines the program. They’re worried about backlash from constituents losing their coverage—in contrast to conservatives who want to see Medicaid expansion completely rolled back.
West Virginia Sen. Shelley Moore Capito “continues to have concerns” about the measure, a spokeswoman said. A spokesman for Ohio Sen. Rob Portman said he hasn’t yet decided whether to support it.
“We’ll review the text and consult with expansion state governors and policy experts in Ohio before making any decisions,” said Portman spokesman Kevin Smith.
Alaska Sen. Lisa Murkowski’s didn’t return a question about whether she’ll back the measure.
Even if all four of those senators decide to support the Obamacare replacement, it’s already on shaky ground because two conservatives—Sens. Mike Lee and Rand Paul—have joined with members of the House Freedom Caucus to condemn it. A third leading conservative, Sen. Ted Cruz, expressed deep hesitations Tuesday at its age-based subsidies for those without employer-sponsored coverage.
“I think that is one of many areas of concern and it is going to be a topic of vigorous discussion within Congress,” Cruz told reporters.
There’s been a growing chorus from conservatives over the past few weeks for Congress to pass a repeal bill from last year, since it has already been approved by the Senate parliamentarian. Since Congress is using a budget reconciliation bill to get rid of the law—requiring just a simple majority in the Senate—there are strict rules saying all its provisions must directly affect federal spending.
“I believe we must start with the 2015 repeal language,” Cruz said. “That should be the floor from which we start and from there we must build upwards.”
But the bill GOP leadership introduced this week also seeks to replace parts of the law, by replacing its income-based subsidies with age-based ones, only gradually phasing out extra federal spending on Medicaid and expanding use of tax-free health savings accounts.
Republicans hope that replacing the law at the same time as repealing it could shield them from political backlash. But now there are questions bubbling under the surface about whether they were too ambitious by adding in provisions that will only get stripped out by the Senate parliamentarian.
Lobbyists and aides say it’s doubtful that the bill’s prohibition on abortion coverage in subsidized plans, its changes to plans’ actuarial value requirements and its immigration verification requirements can pass what’s known as the “Byrd test” for whether they affect federal spending.
But if the Senate is forced to strip out those parts, it could make some conservatives even angrier about the bill. For example, social conservative groups including the Family Research Council are warning they’ll oppose the bill if it doesn’t explicitly block taxpayer-funded subsidies from abortion-covering plans.
“If any healthcare legislation fails to meet this basic test in its final version, pro-life members of the House and Senate must stand should-to-shoulder to defeat the bill,” the FRC wrote in an email to supporters Tuesday.
Nearly every influential conservative group lined up against the Obamacare replacement. Heritage Action and Club for Growth said it falls short of Republican promises to fully repeal the healthcare law. Americans for Prosperity held a rally on Capitol Hill Tuesday to call for total repeal. Freedomworks announced a six-figure ad buy hitting against what it’s calling “Obamacare Lite.”
The Freedom Caucus gathered Tuesday afternoon to oppose the bill, joined by Sens. Paul and Lee. Paul argued that conservatives will be able to sway leadership on the bill if they stick together in opposition to it. “Conservatives want a seat at the table,” he said.
Former Freedom Caucus Chairman Jim Jordan said Republicans didn’t run to only partially repeal the healthcare law.
“Did we promise the American people we were gonna repeal Obamacare but keep some of the Obamacare taxes?” Jordan said. “Did we promise the American people we would repeal Obamacare but we would start a new entitlement?”
There’s so much backlash among conservatives, that Democratic opposition is taking something of a backseat. But Democrats said they’re preparing to offer many amendments to the bill on Wednesday during two separate markups at the Ways and Means Committee and at the House Energy and Commerce Committee.
The goal is to highlight what they see as coverage and cost shortcomings of the replacement bill, Way and Means ranking member Richard Neal told reporters. Democrats will also slam Republicans for the absence of an official Congressional Budget Office score estimating how much the bill will cost or how many Americans it will cover.
“We’re going to challenge them on the premise that they have guaranteed there will be no cutback in access,” Neal said. “We’re going to challenge them on affordability.”
